Prophylaxis for Venous Thromboembolism in General Medical Patients

1 Sep
2010

venous thromboembolism

INTRODUCTION

The incidence of venous thromboembolism (VTE) is predicted to escalate as the population ages, and com­plications of VTE, such as pulmonary emboli, are a signif­icant cause of in-hospital morbidity and mortality. It has been reported that 10% of the deaths observed in hospitals are related to pulmonary embolism and that 75% of these deaths occur in nonsurgical patients. General medical patients admitted to hospital may have multiple risk factors putting them at risk for VTE. Exacerbations of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have been identified as independent risk factors for a venous thromboembolic event1 and have accounted for the majority of general medicine patients admitted to the authors’ institution. The 2001 guidelines of the American College of Chest Physicians (ACCP) recommended the use of low-dose unfractionated heparin (LDUH) or low-molecular-weight heparin (LMWH) for VTE prophylaxis in general medical patients with risk factors for VTE (including cancer, bed rest, heart failure, and severe lung disease) (grade 1A recommendation).

For the 1-year period from April 1, 1999, to March 31, 2000, a total of 95 cases of pulmonary embolism occurred at the authors’ institution, a community hospital with 260 acute care beds. Of these, approximately 80% occurred in nonsurgical patients. A recent audit conducted for the same 1-year period indicated that only 19% of patients with CHF (29/155) and 34% of those with COPD (37/110) received an anticoagulant for prevention of VTE during their hospital stay. Educational interventions were undertaken to disseminate the findings of the audit and to educate physicians, nurses, and pharmacists about current practice guidelines for VTE prophylaxis in medical patients. The purpose of this study was to measure the impact of the educational interventions on the use of VTE prophylaxis according to current guidelines for medical patients admitted with exacerbation of CHF or COPD.
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